Written by Clinical Negligence on September 19, 2017

Group B Strep is the most common cause of life-threatening infection in newborn babies. New guidelines from the Royal College of Obstetricians and Gynaecologists seek to implement better preventative measures.

Group B Strep (GBS) is a bacterium frequently carried in the vagina and the most common cause of life-threatening infection in newborn babies. In particular GBS infections are known to cause meningitis, sepsis and pneumonia and may result in serve disability (including brain damage) or death.

Women who carry the bacteria will usually be unaware of it and their pregnancy may continue without any symptoms or complications. However, once the mother’s waters have broken (i.e. the protective membrane has ruptured) GBS bacteria in the lower vaginal tract can be passed to baby during vaginal delivery.

Once diagnosed, a neonatal GBS infection needs to be treated quickly and aggressively to maximise the chances of a full recovery. However, these infections could be relatively easily prevented with antenatal screening.

GBS bacteria can be readily detected through screening tests such as sensitive Enriched Culture Medium (ECM) testing. Unfortunately this screening is not currently available to the majority of expectant mothers on the NHS and it is not standard practice to screen women for GBS.

The current mortality rate from infection is 2-3% for babies born at term, but as high as 20-30% for babies born before 37 weeks. The Royal College of Obstetricians and Gynaecologists (RCOG) are therefore advocating changes to protect babies born prematurely (i.e. before 37 weeks) who are likely to be at greater risk from infection.

Currently antibiotics prophylaxis is not usually given to women in labour until 24 hours after their waters have broken. The RCOG suggest that any woman who goes into labour before 37 weeks should be offered antibiotics as a precaution, even if her waters have not broken and the protective amniotic sac/membrane surrounding the baby remains is intact. In addition, it is recommended that any mothers who have been tested positive for GBS in a previous pregnancy should be screened at 35 to 37 weeks in subsequent pregnancies to see if they are likely to require antibiotics in labour.

Whilst the RCOG recommendations are to be welcomed for the protective and preventative measures they introduce, they fall short of advocating routine screening for all mothers-to-be.

This is disappointing given the relatively low cost of screening tests for GBS bacteria and the potentially life threatening consequences of such infections.

Jane Plumb, Chief Executive of the charity Group B Strep Support which advocates GBS screening for all pregnant women to reduce the risk of infection has welcomed the new RCOG guideline as “a significant improvement on previous editions”.

There remains scope for improvement in preventative measures and the charity remains dedicated to the pursuit of a vaccine to prevent GBS infections in newborns.

Alternatively, if you have concerns regarding treatment provided for a maternal or newborn infection, or consider that any other aspect of the care you or a family member received during pregnancy and labour may have resulted in an injury to mother or child, then please contact Carolyn Lowe (carolyn.lowe@freeths.co.uk / 01865 781019) or Catherine Bell (catherine.bell@freeths.co.uk / 01865 781140) for a free confidential discussion.

The tribunal bore in mind that Mr Bainton’s misconduct was multifaceted, took place over a number of years and related to numerous areas of his clinical practice as a Consultant Maxillofacial Surgeon. His patients underwent procedures when conservative treatment should have been adopted. These procedures were unnecessary and not clinically indicated.

His insistence on repeating multiple surgical interventions over a number of years to resolve the same problem had the potential to put patients at risk of harm.

His repeated failures indicated a cavalier attitude to obtaining consent. The tribunal was in no doubt that a patient undergoing an experimental procedure should be told the procedure was experimental; in the absence of that information their consent was not informed. His repeated failures to explain to his patients that the procedures he was undertaking were experimental, were heinous , would be considered deplorable by fellow practitioners, and meant that any consent provided by the patients was not informed, undermining the trust at the heart of the patient-doctor relationship.

Roger Bainton was struck off the dental register and suspended by the General Medical Council over a death in Scotland in 1999. He was appointed to North Staffs in 2005, was suspended in 2013 and subsequently dismissed.

Questions now need to be asked:

1. How did he come to be appointed Consultant at N Staffs with that background?

2. Why were those in charge at N Staffs not aware of his practices?

3. Why did his colleagues not challenge and expose his practices?

4. How did the Trust select those patients it chose to write to alerting them to their concerns about him?

In the meantime, we are working with the Trust to resolve the remaining cases outstanding under the Claims Handling Agreement Freeths LLP negotiated on behalf of his patients.

If you are concerned about the treatment you or a loved one has received under Mr Bainton (or the Maxillofacial team at the Royal Stoke Hospital) please contact our Stoke on Trent and Derby Clinical Negligence Team:

Written by Clinical Negligence on September 13, 2017

Following the successful appeal hearing last week a full judicial review will be granted into the decision to downgrade maternity care at Horton General Hospital in Oxfordshire from a consultant to a midwifery-led centre.

With the fight for consultant-led care set to continue it is worth taking a moment to ask what difference the downgrade makes to expectant mothers and their families?

Pregnancies are routinely categorised as high or low risk according to factors such as expectant mother’s medical history, her health and any specific risks that may apply to that pregnancy (e.g. multiple pregnancies). Care for those with low risk pregnancies is usually midwife-led, whilst those expectant mother’s with risk factors for potential complications are likely to be placed under the care of a consultant.

The downgrading of Horton Hospital means that those categorised as high risk are required to travel to consultant-led centres, typically in Oxford, both for antenatal appointments and to give birth. This increases the likely travel time which at best creates inconvenience for those affected as they have to travel further for routine appointments, but at worst could cause a delay in accessing medical care with potentially serious implications for both mother and child.

For many expectant mothers who are considered low risk the downgrade will not necessarily impact on the care they receive. It is normal for these pregnancies and deliveries to be handled by midwifes without consultant involvement. However, if and when complications do arise, for example if labour fails to progress or if the unborn child is in distress, these women would need to be transported by ambulance to a consultant-led centre before urgent medical intervention (such as a caesarean section) could take place.

As a clinical negligence solicitors with considerable experience in birth injury claims we are sadly all too aware of how important timely medical intervention can when complications arise or the delivery does not progress as expected. In circumstances such as this where even a few minutes can make a substantial difference to the outcome for mother and child, it is right that the implications are fully considered and that the decision making process stands up to scrutiny.

If you are concerned about the care that you, or a family member, have received during pregnancy, labour or following delivery, please contact Catherine Bell (Catherine.bell@freeths.co.uk, 01865 781140) for a free, confidential, discussion about your options.

“opponents of the Horton Hospital’s downgrading should be allowed a full hearing into the lawfulness of the public consultation held before last month’s decision to permanently close 45 beds and remove consultant-led maternity.”

Written by Clinical Negligence on September 13, 2017

“Stop Sepsis, Save Lives” is the aim of World Sepsis Day, but what can be done to help achieve this aim?

Sepsis occurs when the body reacts to an infection by attacking its own organs and tissues. According to the Global Sepsis Alliance, sepsis is the cause of at least 8 million deaths worldwide each year. Many of these deaths could be prevented if sepsis were to be recognized in its early stages and timely treatment provided and prevention strategies adopted.

In order to treat sepsis it first needs to be diagnosed. At the outset sepsis can present like flu, a chest infection or gastroenteritis, so it can be difficult to recognize. One of the goals of World Sepsis Day is that by 2020 sepsis will have become a household word and that people will know the early warning signs of sepsis.

The UK Sepsis Trust has summarized the early warning signs. In adults they advise that medical help should be sought urgently if you develop any of the following:

Slurred speech or confusion

Extreme shivering or muscle pain

Passing no urine (in a day)

Severe breathlessness

It feels like you’re going to die

Skin mottled or discoloured

In children they advise that any child demonstrating the following symptoms might have sepsis:

Is breathing very fast

Has a ‘fit’ or convulsion

Looks mottled, bluish, or pale

Has a rash that does not fade when you press it

Is very lethargic or difficult to wake

Feels abnormally cold to touch

If these symptoms arise you should seek urgent medical advice and ask “could it be sepsis?”

It is also vital that medical professionals are able to spot the warning signs of sepsis and that treatment is provided as soon as possible. Treatment is by antibiotics, often together with fluids and oxygen.

Although there has been increased awareness of sepsis recently, largely as a result of campaigns such as those organized by the UK Sepsis Trust and the Global Sepsis Alliance, there are still improvements which can to be made within the NHS to prevent avoidable deaths and other potential complications.

The National Institute for Health and Care Excellence has released a quality standard today which recommends that people with life-threatening sepsis receive treatment within one hour, and provides other priorities for improving the treatment of sepsis. We support the on-going focus on better sepsis treatment within the NHS and hope that this will reduce the number of avoidable deaths and adverse outcomes in future.

If you or a loved one have been affected by delay in diagnosis or treatment of sepsis please contact Lucy Habgood (lucy.habgood@freeths.co.uk, 01865 781093) for a free, confidential, discussion about your options.

Written by Clinical Negligence on September 12, 2017

For 12 years The Royal College of Midwives (RCM) has encouraged women to give birth “naturally”; meaning vaginally, without drugs and without medical intervention. During this time, many of those women needing help to deliver their children felt that they were not appropriately supported, treated or informed of their options. Over time, the discourse about child birth in society and in the media, has rightly accepted of any form of delivery, including assisted delivery and caesarean sections.

In turn, the RCM has recognised that it is time to bring their campaign for a natural delivery to an end. The RCM’s chief executive, Professor Cathy Warwick, told The Times, “There is a danger that if you just talk about normal births – and particularly if you call it a campaign – it kind of sounds as if you’re only interested in women who have a vaginal birth without intervention. What we do not want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth. Unfortunately, that seems to be how some women feel”. The RCM has now announced that women will no longer be told that they should have babies without medical intervention.

It is clear that many women do require assistance with their baby’s delivery. Medical intervention may be needed during labour due to a number and often a combination of reasons including, the size of the baby, the size of their own anatomy, the baby being in a difficult position or becoming stuck, fatigue, and a whole host of other serious complications.

Sadly difficulties with a baby’s delivery, especially those which are not dealt with adequately, can lead to damage to both mother and baby. Figures show that claims against maternity units for negligence related to births leapt by almost a quarter in 2016. Parents made 232 claims against the NHS in 2016/17, the highest figure for 11 years. The total value of compensation paid for brain damage and cerebral palsy was around £1.9billion, according to the 2016/17 annual report of NHS Resolution, which handles litigation action against the NHS.

Many believe that the cause of this rise in obstetric claims is not only due to staff shortages but also due to the fixation on natural births with minimal medical intervention. The drive for natural births attracted criticism following an inquiry into the deaths of 11 babies and one mother at the Morecambe Bay trust between 2004 and 2013, which found midwives’ desire for normal births at any cost had contributed to unsafe deliveries.

Patient safety specialist James Titcombe, whose baby Joshua died due to failings at Morecambe Bay NHS trust in 2008, said: “The idea of normal birth at any cost has had dangerous consequences. Part of this is the language makes women who don’t have a “normal birth” feel like a failure, but it’s also about the fact it leaves too many women and babies at risk, at a point when midwives should be asking for help [from doctors].”

Peter Walsh, Chief Executive of the Action against Medical Accidents (AvMA) campaigning group, has commented, ‘More research needs to be done, but moving away from the cult-like fixation with so-called “normal birth” is a step in the right direction. Health minister Philip Dunne has also welcomed the end of the RCM campaign for normal births adding, “The NHS is already one of the safest places in the world to give birth, but we want NHS maternity care to be even better and have made tackling such tragic failures a priority.”

In the Clinical Negligence department at Freeths LLP we act for families affected by birth injury to mother or baby. We are encouraged that the campaign for natural births has come to an end, and we hope that patient safety for each individual continues to be a priority. If you are concerned about the care that you, or a family member received during or following labour, please contact Claire Cooper on 0845 274 6830 for a free discussion about your options.

Mr Hunt cites the tragic case of Wayne Jowett who died in 2001 after a cancer drug was wrongly injected into his spine instead of into a vein.

The drug in question was Vincristine, one of two drugs with which Wayne Jowett was being treated with for Leukaemia. Vincristine has to be administered into a vein. If it is injected in to the spine then it causes severe pain, spasms, paralysis and invariably death.

Freeths’ Paul Balen represented Wayne Jowett’s family at the inquest after the death of the 18 year old apprentice mechanic and stock car enthusiast 16 years ago as well as in the subsequent clinical negligence claim.

“It took over 5 years to introduce design changes to prevent the error which killed him and that medication error was already a “never” event. I vividly remember receiving a letter from a still grieving mother whose child had died as a result of the same error 25 years before Wayne’s death. There had been an inquiry following that death as well. It is essential that lessons are learnt when mistakes happen and that the minister demonstrates effective action to back up his stated intentions.”

Never events by their very definition are mistakes that should not have occurred once – to see them repeated is unacceptable. As clinical negligence solicitors we understand that human error cannot always be entirely avoided, but with adequate safeguards mistakes of this serious nature can and should be.

It is hoped that Mr Hunt will ensure the necessary time and resources are invested in training, new technologies and procedures to ensure that no future patients suffer unnecessarily in the way Wayne Jowett did.

“Doctors have previously warned about patients getting the wrong drugs because handwriting on prescriptions was illegible or medicines with similar names had packets that looked the same as each other. Mr Hunt cited the case of Wayne Jowett, 18, who died in 2001 after a cancer drug was wrongly injected into his spine. Equipment has since been redesigned to make this impossible but Mr Hunt argued: “Should it really have taken a tragedy to precipitate change? By giving this issue more profile, we can do much more to create a proactive, safety-centred culture around medication.”

If you think that you or a loved one may have been injured as a result of a medication error or negligent medical care, we may be able to help you. Please contact either Paul Balen in Nottingham on 0845 050 3289/paul.balen@freeths.co.uk or Catherine Bell in Oxford on 01865 781140/Catherine.bell@freeths.co.uk for a free discussion about your options.…

Written by Clinical Negligence on July 31, 2017

According to NHS statistics, between April 2007 and March 2015, over 92,000 women had vaginal mesh implants fitted in England. There are various types of vaginal mesh but a commonly used mesh is transvaginal tape. The transvaginal tape is used to treat women who suffer with incontinence problems after childbirth and pelvic organ prolapse which occurs when the bladder pushes against the vagina’s walls.

It is reported that around 1 in 11 of those women who have vaginal mesh implants experience complications. Complications include chronic pain, nerve damage, the inability to walk and the inability to have intimate relationships as a result of the mesh breaking into tiny fragments or protruding through the vaginal wall.

The BBC has revealed that more than 800 women in the UK are taking legal action against the NHS and manufacturers, including the US pharmaceutical giant Johnson & Johnson, who are the biggest makers of mesh implants.

A campaign group called ‘Sling The Mesh’ has already garnered significant support and their website confirms that women as far as Australia are campaigning to have this type of surgery banned. Australian Senator Derryn Hinch, who is backing the campaigner’s fight, has publicly stated that the vaginal mesh implants could be the worst medical disaster for women since Thalidomide. Many women are extremely angry that the risks inherent in such surgery were not properly discussed.

NHS England set up the Mesh Working Group to address the safety concerns about the use of mesh implants. A Report published in July 2017 has been met with criticism by campaigners and Labour MP Owen Smith who noted that the Report was an opportunity for the NHS to take the lead and recommend a pause in the use of mesh until the precise number of women who have been adversely affected could be identified.

A spokesperson from The Medicines and Healthcare Regulatory Agency (MHRA), the government watchdog, has said;

“What we have seen, and continue to see, is that evidence supports, and the greater proportion of the clinical community and patients support, the use of these devices in the UK for treatment …”

However with more and more women joining support groups and seeking legal advice amid growing concerns about the use of transvaginal tape and other similar mesh implants, it remains to be seen whether public confidence in the use of such materials can be maintained.

If you think that you, or a loved one, may have been affected by negligent medical care, we may be able to help you.

Written by Clinical Negligence on July 13, 2017

An annual survey shows that in England, 20% of people must wait at least seven days to see a doctor, with many unable to get an appointment at all. Statistics show that the number of patients waiting over a week to see their GP has risen by 56 per cent in the last five years.

GP’s have claimed the NHS is at “breaking point”. Despite doctors stating that they are working flat out and under unsustainable pressure, the NHS have done little to resolve the issue of at least one million patients a week unable to get a GP appointment.

For those who do continue to seek medical advice, they often turn to Accident and Emergency departments instead. However, many are failing to attend any appointment at all, putting the vulnerable at further risk despite their need for basic care.

GP surgeries have been struggling for decades to keep up with the aging generation. There are now one million more people are over the age of 65 than five years ago, and it seems the government’s under investment into the health sector is coming into fruition. On top of overworked GPs, surgeries have been closing across the country, forcing the remaining to merge and take on the strain of more patients. Last year, the Freedom of Information request revealed that 58 practices closed completely, whilst another 34 surgeries had to close due to practice mergers. Patients are required to travel greater distances to see a GP, putting pressure on the number of appointments a surgery can accept.

All these concerning statistics highlight the difficulties in ensuring good standards of care across the country. The full impact of reduced appointments and closures will continue to unfold throughout 2017.

“It is a crazy situation. GPs are ridiculously overworked and there are too few of us – the situation is on the brink.” – RCGP president, Dr Helen Stokes-Lampard.

In response to this, the government has called for extended opening hours at evenings and weekends to alleviate the growing pressure on emergency departments. This isn’t a long-term fix, and there have been extensive criticisms of doctors being overworked, as well as the issue of rushed GP consultations, which can put patients at risk where misdiagnosis and clinical negligence can ensue. This increased pressure on GPs and Accident and Emergency services means that things could get missed, resulting in life threatening consequences. Through better funding of these services the risks can be reduced.

At a time when the media and the government seem focused on cutting the cost of negligence claims, this highlights an opportunity to reduce negligence and therefore the cost of claims in a more effective and fair manner than would be achieved by denying adequate compensation and restricting access to justice for those patients who have suffered injury.

If you believe you or a family member has been injured as a result of a poor standard of care from your GP, please contact Carolyn Lowe, Partner, on 01856 781 019 / carolyn.lowe@freeths.co.uk, for a free discussion about your options.

Written by Clinical Negligence on July 5, 2017

What is Group B Strep?

Group B Strep (GBS) is a normal bacterium carried in the vagina that is the most common cause of life-threatening infection in newborn babies. It is known to cause serious illness including meningitis, sepsis and pneumonia.